Help me help my anxious, bipolar, stressed-out friend.
February 22, 2010 10:40 AM   Subscribe

What more can I do to help a very dear friend who suffers from bipolar disorder and is currently having a very difficult time, both as a result of his illness and due to outside factors? I am also bipolar, so I kind of know what he's going through. Lengthy but informative explanation of his circumstances and history follows.

My very good friend and boyfriend's roommate (let's call him Jacob) is having an extremely rough patch of depression/anxiety at the moment, frequently staring into space and generally seeming to be a world away. I have never seen anyone in the state that he's in, and I'm incredibly worried. He's bipolar (I don't know for sure, but from observing him I'm guessing type II), relatively recently diagnosed, but not currently in regular treatment for it. He is currently quite depressed and has been for some time now (at least a few weeks). He no longer enjoys the things he used to—he told me yesterday about a very funny book he's reading and how it sucks because he can't enjoy it even though he knows it's good. He's also extremely anxious and stressed out all the time for no reason, to the point where he constantly feels that won't be able to take it any longer. He has seen a psychiatrist about it but doesn't like the doctor much and is hesitant to return, although he told me today that he's going to make an appointment this week. Unfortunately he doesn't have health insurance, so continued treatment would be difficult for him. The doctor is also located in his hometown, about an hour away from where we live.

His problems are exacerbated by an extremely difficult family situation. He's the youngest of three children (he's 21). His oldest sister (around 26, call her Jenny) has paranoid schizophrenia and is also bipolar. She's exhibited symptoms for as long as he can remember and will likely never be able to live on her own or have a normal life. She has been in and out of hospitals many times, and his mother has long since quit her job to take care of her full time. His other sister (Tina) is very intelligent but suffers from moderate to severe OCD. I believe she also lives at home, though I've never met any of them and only know what he's told me. He's not very close with either of them and I think he resents Jenny for what her illness has done to the family, but he wishes he were closer to Tina. He resents his father (who is also bipolar) deeply, saying he was never there for him growing up and was always emotionally distant, possibly as a result of Jenny's need for constant care. He's even told me that he wishes his father had simply been absent growing up, as that would be easier than living in the same house but feeling ignored and neglected. He recently expressed this to his father over the phone, which has only made him feel worse. He also has issues with his uncle on his dad's side, who has very little contact with his family in spite of living very near them. The uncle is also fairly well off as Jacob's family struggles with financial troubles. He even suspects that his uncle may have killed his (Jacob's) grandmother, as he was the only person in the room when she died and afterward announced her death very matter-of-factly. He says his grandmother was the only person holding the family together, and ever since her death everything has only gotten worse.

As I am also bipolar (type II) and have gone through a lot of what he's currently feeling, I've been trying to help him out as much as possible. He's talked to me about how he's feeling more than anyone else, as he feels others wouldn't understand and is reluctant to open . He is hesitant to use prescription anti-depressants, having previously been on Cymbalta, which he says helped him but zapped his ability to make good decisions (while taking it he bought a $2000 flatscreen TV which he says he never would've otherwise). I have also been on Cymbalta, though not currently, and I know it can encourage manic and hypo-manic episodes in bipolar individuals, which I suspect may be the answer. His doctor recently prescribed Lamictal, which he was hesitant to take but tried after my encouragement. He says he took it for a few weeks but then felt better, so he decided he didn't need it and tossed it, which he later regretted. I also take Lamictal and had an extra bottle from when I quit taking it for a while, so I gave him that until he sees his doctor again. My prescription is a different dose, but he uses a pill cutter to get the dose his doctor told him to take. I know that sharing prescriptions is in general a very bad idea, but as he had already been prescribed it and saw some improvement from it, I decided that in this case the good outweighed the bad. He's only been back on it for a little while, however, and has yet to see major improvements in his state. He still finds his anxiety almost intolerable and has been trying to self-medicate with marijuana and alcohol, though he has been trying to cut back or quit both. He has also been trying desperately to find some Xanax, which terrifies me. He has in the past (~1 1/2 years ago) abused illegally-obtained Xanax, sometimes crushing it up on his coffee table and snorting it in front of his friends, all of whom were extremely worried about him. He quit after being confronted by a friend who basically said he was probably addicted and had to quit or lose the friendship and the business they shared. I know how risky benzos can be and have told him so multiple times, but he says that they help him, though I think he'd prefer to take legally prescribed anti-anxiety medication in the proper manner. Part of my dilemma is that I have a bottle of Buspar, a non-benzo, non-addictive anti-anxiety medication with very few side effects or risks (as far as I can tell from internet reserch), which he has been begging me to give him to help him out. At this point, I'm inclined to do so, as I'd rather he take 10 mg of a low-risk but illegally obtained anti-anxiety medication than snort larger quantities of possibly deadly and also illegally-obtained Xanax. I know I legally shouldn't do this, and I have some hesitation about it, but I feel that this could possibly save his life.

I have encouraged him to seek therapy, an idea he is receptive to but unsure about. Since he doesn't have health insurance his only real option would be the student counseling center at our university, but he has doubts about their confidentiality. He saw someone there his freshman year and expressed to her that he had suicidal thoughts (though he never made any attempts or plans), which she then told to his R.A. who put him on a sort of suicide watch. After this, he feels that anything he told them wouldn't be kept between them. I've told him that in most cases, therapists are bound by moral and ethical (and legal? I don't know) restrictions of confidentiality, which are overridden only by concern for self-harm/suicide or plans to hurt others, but he's still hesitant. I think he's going to give it a try, however, which I think is a good first step. While I don't think he is suicidal in the sense of actually making an attempt, I do know it's something he thinks about, and I think at this point he's somewhat apathetic about life. He does want to get better, though, which makes me think he's somewhat more committed to living than not. He still engages in reckless behavior, driving drunk at an alarming frequency. I've tried everything I can think of to get him to stop, including giving him the number for a Designated Driver service that would drive him home in his own car, offering to pick him up, taking my boyfriend to drive his car home as well, asking him to imagine living the rest of his life with the guilt of killing an innocent person, and to consider going to prison for it. When he's sober he agrees with me about this stuff, and last night even promised he'd call me if he got drunk at the party he was going to, but then he drove home anyway. He knew today that it had been a mistake, but in the moment he made that decision. (I had tried to follow up with him later that night to offer again to pick him up, but his phone had died). Today we got lunch together and he drove, and during the trip I again expressed my concern for the rate at which he drives recklessly. I told him that it scares me and admitted that I worry a lot about him, to which he replied he was glad someone did. He said he knew his death would affect lot of people, and I asked him how his mother would react if he died. He said she'd probably fall apart and not be able to continue, which I think got to him more than any of the other stuff, though time will tell.

At this point, I'm extremely worried about him. I don't like to leave him alone, and while I don't think he'll kill himself purposely, I fear he might indirectly bring about his own death through recklessness or substance abuse. I know he values my friendship and appreciates my willingness to listen and how much I care for him, but that doesn't change what he's going through. I've tried to guide him in the right direction, telling him what worked for me and emphasizing that this won't last forever, but I want to do more. This is a great, kind, smart, funny, and all-around beautiful person, and I don't want to lose him to a freaking chemical imbalance in his brain. I need to know what I can do to help him, beyond just being a good friend.

Some random details that may or may not be helpful:

-He's Jewish, and while not particularly active in the temple (I think he mainly goes on holidays), his faith is very important to both his identity and his spiritual wellbeing. He's been to Israel previously, is planning on going back this summer, and has considered moving there when he's older. He has mentioned his hypothesis that the stressful nature of life may be why many Jews pray frequently, to which I suggested he might also pray.

-We live in the U.S., in a smallish (~50,000 people) college town in a southern appalachian state.

-He and I are both 21, my boyfriend/his roommate is 32, and their other roommate is 24. Said roommate is bisexual, which is no problem with anybody, but he confessed his love for Jacob the first night after they moved in together in August (Jacob's straight). This put a strain on their relationship and caused stress for Jacob, although I think the roommate has gotten over his feelings by now. They're currently trying to find another roommate to replace the crazy one that screwed them over. He and Jacob recently had a falling-out after being friends for seven or eight years, bumming him out immensely.

-His dad's 57th birthday is coming up this week, and he's stressed about whether or not to go.

-He's single, and says he prefers it that way, though he seems to crave a sort of emotional intimacy with someone. He doesn't seem to understand my relationship with my boyfriend and how we do it (he likes us both and has no problem with it, he's just never had a long-term relationship and doesn't really get why we do it). He goes out to bars and parties trying to score with girls but usually isn't that successful. He's a really attractive and all-around great guy that I think girls would like if he'd be himself rather than trying to be a shmoozy player, but whatever.

-He has trouble in school because he doesn't know how to study and has trouble staying on task. He's been diagnosed with ADHD and takes adderall for it.

-He's fairly active and athletic, going to the rec center often, and this seems to help him. He says that yoga is the only thing he's tried that really helps his anxiety.

-He also seems to exhibit symptoms of seasonal affective disorder, saying he's "always like this when the seasons change." I told him about the full-spectrum lights made for this purpose, and he seemed interested.

I know this is really long, and I thank you for reading it. I really hope someone out there can help me. I've tried to include as much information as I can, but if anyone has questions they need answered I'll follow up with a mod. My throwaway email for this is Any and all suggestions are welcome.
posted by anonymous to Human Relations (6 answers total) 2 users marked this as a favorite
I have a friend who recently found himself in similar circumstances. Different mental disorder, but still in the anxiety spectrum...

Anyway, your friend might not realize this, but being in school -- which he admittedly sucks at -- is just one more huge source of anxiety on top of everything else. And it's one of the big sources of anxiety he has some control over right now.

Far be it from me to just say, "drop out," but really, being able to turn off a source of anxiety like that really helped my friend. It sucks to wake up every day to another day of being walked through different areas (classes) in which you are failing or doing poorly.

Other than that, your friend is not in therapy and won't stay on meds. Well, he's bipolar, so that is not terribly uncommon. But insofar as these problems are caused by his anxiety, maybe you can relate it to something he enjoys? It is a bit like being in training for something, and following rigorous rules...maybe you can follow him to the gym someday and shout mantras in his ear while he works out? "YOU'RE GOING TO GET BACK IN THERAPY, SCREW WHAT ANYBODY ELSE THINKS!!! YEAH!!" (Geez, who's bipolar now, lol) But you get the idea. But he CAN change those attitudes about therapy and pills, and his mental reasoning there isn't that strong. See if you can budge him. This worked with a bipolar roommate of mine.

Do you have any friends who are doctors? I have a bro-in-law who is one, and it REALLY helped to be able to offer this roommate something like, "hey, want me to call my doctor relative and see what he thinks about your therapy concerns?" Befriending somebody like that could only help. Or just call a nurse at the hospital or something. My bipolar roommate went all trace-minerals on himself and was downing like 50 vitamins a day, and it just about destroyed him...finally called my bro-in-law and a great discussion of concerns and solutions followed.

Anyway, don't forget to take care of your own anxiety problem during all this. Bipolar types like to really go to bat for other people with a passion. But you also realize that there can be an unhappy ending here. Why not write down your thoughts about it? About your relationship with him? You could even write him letters -- you and all your roommates could make him a video or something he can watch when he's bummed out.

Be good to yourself, be open with your feelings about him.

Also I have a bipolar cousin who is a total schmoozer. Drives me nuts, not sure where he picked that up...but man, sometimes it just works against him, you know? lol
posted by circular at 11:06 AM on February 22, 2010

He NEEDS to be actively participating in therapy. Pay for it out of pocket. Tell him, you NEED food and you pay for it out of pocket. You need mental health just as much. So get over any notions about it has to be paid for by someone else or an insurance plan. If you don't spend the money your life WILL get worse. There are lots of other therapists out there, do not put up with one that doesn't fit. Do not waste the time and money, move on to another one. Drugs can work wonders but not without interactive and open therapy.

As for the family issues, suggest he take a break from all of it in order to get his own shit together FIRST. They'll still be there (and likely still just as fucked up) once he's made some progress on his own issues. It's a mistake to try and juggle all of them at one time. Pick the important battle first, his own mental health.
posted by wkearney99 at 11:09 AM on February 22, 2010

By the way, with regard the religion issue -- I wonder if there's somebody in the local congregation that can help him? One of the leaders? In my church, you are literally a phone call away from great counseling services or at the very least a good referral, and with full confidentiality.

It may feel to him like he needs to approach any religious activity with extreme piety and devotion, but if so, please help him realize that this can be a big time symptom of anxiety disorders. I have a relative who really struggles with scrupulosity, praying like once every five minutes or so, repeating lots of "please forgive me's" and "please grant me XYZ" and whatnot.

To the non-religious, it probably seems like every religious person does that, but it really is a caricature. It's the same thing as running across people with anxiety disorders who have put on way too much makeup, or way too nice clothes, etc.

Anyway, he is part of that community by birth, and I'm willing to bet somebody in that group could be just as helpful to him as you are.
posted by circular at 11:18 AM on February 22, 2010

Jeez. What a situation. I really empathize--I have a depressed/anxious friend who's doing much worse than I am, and I find myself trying to help her because I've been where she was and I desperately needed someone to help me... and it gets into this "god, I wish I'd had this kind of help" and so you almost feel obligated to help him because it's like helping yourself when you were worse. If that makes any sense.

So if you're feeling that, divorce yourself from that feeling of obligation. First and foremost: take care of yourself first. You are not his therapist. You are not his psychiatrist. You are his friend and as his friend, please stop giving him drugs. If he decides to go get illegal Xanax or whatever, that is HIS decision, but you could get in a shitload of trouble for giving him drugs. Take care of yourself first. The possible consequences of you giving him drugs are much worse for you than for him.

If he consistently drives drunk, and you've already given him the carrot of "hey, call me, or call a taxi, or call this DD place"... he's not going to react to the carrot, obviously. So bring out the stick: tell him that the next time you have reason to suspect he's going to be driving drunk, you're giving the police his license plate, the general location, and telling them that he's likely to be drunk. Again, look at the possible consequences of his driving drunk. There are things much, much worse that could happen than getting picked up by the police, and he NEEDS to understand that. If anything, perhaps it'll prevent him from putting the keys in the ignition to think "shit the police already know I'm drunk driving, they're just waiting to pick me up." And ideally he'll think "better not do this then."

Right now he doesn't sound like he understands the consequences of his actions. He's just reacting, not acting: he gets drunk, so he drives home drunk, whatever. He's depressed, but he's not going to seek therapy or go to his psychiatrist because of whatever reason, whatever. He takes some meds, feels better for awhile, doesn't know if it's worth it or not, so whatever, stops taking them.

He needs to start acting, because the path that he's on is a scary, scary one and you're right to worry that it'll go badly. Your job as his friend is to encourage him to do so. NOT to do it for him. Refer back to the first thing I said and take care of yourself first.

If you're taking care of yourself first, then it's okay to help him with his problems. So if he doesn't like his psychiatrist or it's too far home, help him FIND A DIFFERENT ONE. If he doesn't think that the counselors at the school will honor his confidentiality and is reluctant to go, go with him to the first session or the first 15 minutes and explicitly ask them "Under what circumstances will you breach confidentiality?"

As for the family issues, that should really be addressed in therapy. A good therapist can help him decide whether to cut off contact with them or not, etc.

Please MeMail me if you want further clarification or if you just want someone to commiserate with, because I really do sympathize & understand what you're going through.
posted by saveyoursanity at 4:20 PM on February 22, 2010 [1 favorite]

I found in my own struggles with the illness, that you can just get 'stuck' and repeat unhelpful behavior over and over again.

Some things that have helped me in the past, while I was waiting to get meds to kick in:

- make a schedule and have a support group (not just you) help him stick to it. Up by 9, shower by 10, eat, do a chore, etc. Some days the shower itself is just a victory.

- get a list of small, easily achieveable things to do and do 1-2 a day (depending on energy). It can be as simple as making a phone call.

- join a support group. they really help. I found NAMI to be the best:

- leave the house every day and get at least 20 minutes of exercise. fresh air and sunshine are natural anti-depressants.

- eff the confidentiality and get therapy. Bipolar still has a stigma, but not as much as untreated bipolar. This is a life and death situation here, and should be treated as such. He's showing self-destructive urges, and that needs to get smacked down rightnow.

- eat a healthy diet low in carbohydrates. Bipolar is a very hormonal disease, and giving your adrenal glands, thyroid and other areas less latitude to mess with your serotonin helps. Plus, it can help with digestive upsets, which are common and gross. A mutlivitamin doesn't hurt.

MeMail me if any of these things feels helpful.
posted by beezy at 7:36 AM on February 23, 2010

I'm not bipolar, but I've been quite majorly depressed and pseudo-suicidal for almost a decade, though I have recently recovered. As such, I might not relate quite perfectly but I think that some general points that helped me may help the situation.

1) Change needs to happen. If going through every day doing certain things does not make him happier, then by logic it would make sense to try something different. A mix in schedule could help; circular suggested that perhaps taking a break from school for a while may help. It may or may not, but the truth is that he really needs to mix things up or he will always get the same results.

2) Regarding the therapy, though in my experience I have found it ineffective through several therapists/counselers, every person gets something different out of it. But if, say, there's even a 1% chance that therapy COULD get him better, then ask him: Does he really, really want to get better? And if the answer is yes, then shouldn't he be leaping at every little opportunity, however small, that could possibly have the answers he seeks?

You say he does not have the funding for a proper psychiatrist right now, so the next question is how to solve this problem. A job would probably be too stressful and not help his situation at the moment, but don't rule out the possibility. Propose to look for a suitable one for him together. For example, if he likes animals, perhaps working at a pet daycare would be nice. If this effort seems to come out fruitless, more brainstorming may be necessary, but as saveyoursanity mentioned, don't give up too much of your life for him unless you truly feel that you would regret it otherwise.

Circular also mentioned the possibility of connections. With the right social circle, it may be possible to get him some help without ever shelling out a buck. I am assuming that the fact that you have not mentioned this means that you currently do not have such connections. You probably don't have the time or energy to run out and search the world for such connections, so instead just keep a keen eye out for any situations where you may have an opportunity to meet such a person.

3) Because of my depression I understand that sometimes, he will simply not be able to do anything. He will feel helpless and simply react to his overwhelming depression, unable to properly do anything that could be productive in helping himself. In my case, I would retreat to marijuana/alcohol/prescribed anti-depressants. And quite frankly, they did help in the times I could not cope at all and might have done something drastically stupid or inflicted self-harm. But the problem with these is that they only help cope, they do not solve anything, and it's not beneficial for him to take these for the rest of his life, he might as well just be a vegetable.

When he is not able to pick himself up in these times, this is where you come in. Stick to my theme of mixing up things every once in a while, and see if you can manage to introduce him to new things, whether it be a new place to just hang out, new friends, or maybe even work at a new project together.

If in the case he is not receptive to these things, then your best bet may be to encourage these productive actions while he is on his medication, as he will then at least be in a more coping mood and may be more open to possibilities. Conversely his medication may make him feel complacent since it is making him feel better at the moment, so you will need to judge this situation yourself.

I will send you an email, we can continue discussing this later.
posted by formaltide at 7:58 AM on February 23, 2010

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